chap, ix.] THE NECK. 147 



in the anterior triangle in front of the depressoi-s of 

 the hyoid bone would probably come forward, owing 

 to the thinness of the fascia in front of it; but, if 

 pent up, it would tend to progress towards the 

 anterior mediastinum, or into the lateral parts of the 

 neck in front of the carotid vessels. (3) An abscess 

 behind the hyoid depressors and about the trachea or 

 thyroid body, or in the immediate vicinity of the 

 carotid vessels (an abscess situate, in fact, between 

 the deep fasciae Nos. 1 and 2) would find itself in 

 a narrow strait, and, after pressing much upon 

 adjacent parts, would most readily spread down- 

 wards into the mediastinum. (4) An abscess imme- 

 diately in front of the spine, and beneath the deep 

 fascia No. 2, might extend down into the posterior 

 mediastinum, or move towards the posterior and 

 lateral parts of the neck, following the brachial 

 plexus, and so reach the posterior triangle, or even 

 the axilla. 



In many cases a cervical abscess has burst into the 

 gullet, or trachea, and even into the pleura. In some 

 instances the great vessels have been opened up. In 

 one remarkable case reported by Mr. Savory (Med. 

 Chir. Trans., 1881), not only was a considerable 

 portion of the common carotid artery destroyed by 

 the abscess, but also a still larger portion of the 

 internal jugular vein, and a large part of the vagus 

 nerve. This, and like examples of the destructive 

 action of some cervical abscesses, depend, no doubt, 

 upon the unyielding character of the cervical fascia, 

 which hems in the pus on all sides, and drives it 

 to resort to desperate measures to effect an escape. 

 " It is noteworthy," remarks Mr. Jacobson, " that 

 communications between abscesses and deep vessels 

 have usually taken place beneath two of the strongest 

 fasciae in the body, the deep cervical fascia and the 

 fascia lata " (Hilton's " Rest and Pain "I 



